In 1953, Robert Knight, Director of the Menninger Clinic in Topeka, Kansas, wrote an article on a new personality. 1 He called these patients “borderline” and by the mid-1960s this had become a most compelling diagnostic term, first in the United States and then in Europe and around the world. Then, in 1975 Otto Kernberg (himself on the staff of Menninger in the 1960s and early 1970s) produced what was arguably the most important work in psychiatry and psychoanalysis of that era: Borderline Conditions and Pathological Narcissism. 2 No text has had a greater influence on clinical practice in modern times.